Dr. Christian Torp-Pedersen from Bispebjerg University Hospital, Copenhagen, Denmark and colleagues in the Carvedilol or Metoprolol European Trial (COMET) investigated whether carvedilol was associated with a different incidence of new onset diabetes compared with metoprolol in more than 3000 patients with chronic heart failure.

Patients taking carvedilol were 22% less likely to develop new onset diabetes than patients taking metoprolol, the authors report. New onset diabetes was diagnosed in 119 out of 1151 (10.3%) of patients taking carvedilol, versus 145 out of 1147 (12.6%) of patients taking metoprolol.

Diabetes-related adverse events were also 22% less likely to occur among carvedilol patients: 122 events versus 149 events.
Metoprolol remained an independent predictor of new onset diabetes in a multivariable model that included body mass index, hypertension, functional class, and other factors.

Patients treated with metoprolol also showed a significant trend for an increase in random blood glucose levels over the course of the trial, the investigators write.

Treatment with carvedilol was associated with a nonsignificant risk reduction for mortality compared with metoprolol for diabetic and nondiabetic patients, the researchers note.

In a multivariate analysis, however, treatment with metoprolol and a diagnosis of diabetes were independently associated with greater all-cause mortality.

"This study demonstrates that treatment with carvedilol is associated with less development of new onset diabetes in patients with heart failure compared with treatment with metoprolol tartrate," the authors conclude. "The study further demonstrates that not only is the prevalence of diabetes high in patients with heart failure but also the incidence is high, amounting to 10-15% over 5 years."

Heart 2007;93:968-973.

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